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The building sector worldwide is responsible for massive CO2 emissions. These emissions stem from both existing and newly constructed buildings, particularly from the extraction and production of materials. Solutions include promoting circular construction, smart investments, and political measures. However, information on materials, quantities, and routes is often incomplete or inaccessible. The “Colouring Dresden” project aims to gather, explore, and communicate knowledge about buildings via the open platform “Colouring Dresden”, part of the international Colouring Cities Research Programme (CCRP). It is Germany’s first citizen science project focused on data collection and disclosure about the built environment, especially buildings. In collaboration with stakeholders, the project developed research questions, adapted the platform, prioritized data collection features, and established citizen science actions and communication channels for knowledge transfer. These actions and knowledge transfer were crucial to the project’s success. Various evaluation methods assessed their suitability in citizen science, providing insights into participant motivation, interests, and benefits for science, society, and individuals. The evaluation revealed significant differences in response quantity and data quality during data collection. The results demonstrate that citizen science projects can be effective in the built environment context, offering insights into appropriate action formats and evaluation methods. This contributes to the advancement of citizen science in Germany, enabling targeted planning of future urban citizen science projects to enhance participant motivation and collect information to reduce CO2 emissions in the building sector.

This paper demonstrates an approach to the problem of micro-scale analysis of medical service provision in Germany. Research focuses include estimating population dynamics, mapping access to medical facilities and identifying spatial patterns in medical service provision. We applied the Enhanced Two Step Floating Catchment Area method to quantify changes in access to primary care physicians over a period of eleven years. Our study reveals that overall access is modestly rising, but significant spatial disparities exist between different regions of Germany. We describe both supply and demand issues behind the observed changes in access. As a key result, we identify four types of regions with differing access-population dynamics. Our main conclusion on the topic of medical service provision is that spatial planning is facing a multi-dimensional problem rather than a one-dimensional one, and that access to services depends on a combination of factors. Concerning differences between rural and urban regions, we find that that there is no general positive or negative trend for either.

Worldwide, COVID-19 has decimated healthcare systems and highlighted the pressing need to ensure resilience for future pandemics. Given the almost 30% likelihood of another respiratory disease similar to COVID-19 manifesting in the next 10 years, it is imperative to prioritize pandemic preparedness in the immediate future. To this end, tuberculosis (TB) and its management share many similarities to respiratory disease protection, offering an opportunity to dually strengthen TB programs and protect against future pandemics. Looking at data from the World Health Organization (WHO), Global Fund, Our World in Data, and domestic health ministries, it was hypothesized that countries that had better TB program strength going into the pandemic fared better with COVID-19 than those with poorer TB treatment. It was found that countries that recovered their TB program strength (as measured by TB treatment coverage percentages) to or above pre-pandemic levels fared better in terms of COVID-19 pandemic incidence and death. Case studies helped identify common factors across resilient TB platforms in dually successful COVID-19 and TB countries, including community trust, co-epidemic responses that were able to maintain continuity of care, sustained innovation, comprehensive communication across public and private sectors, and maintenance of donor support for TB programs through the pandemic.

Abstract Background Rotavirus is the leading global pathogen of diarrhea-associated mortality and poses a great threat to public health in all age groups. This study aimed to explore the global burden and 30-year change patterns of rotavirus infection-associated deaths. Methods Based on the Global Burden of Disease 2019 Study (GBD 2019), we analyzed the age-standardized death rate (ASDR) of rotavirus infection by sex, geographical region, and sociodemographic index (SDI) from 1990 to 2019. A Joinpoint regression model was used to analyze the global trends in rotavirus infection over the 30 years, SaTScan software was used to detect the spatial and temporal aggregations, and a generalized linear model to explore the relationship between sociodemographic factors and death rates of rotavirus infection. Results Globally, rotavirus infection was the leading cause of diarrheal deaths, accounting for 19.11% of deaths from diarrhea in 2019. Rotavirus caused a higher death burden in African, Oceanian, and South Asian countries in the past three decades. The ASDR of rotavirus declined from 11.39 (95% uncertainty interval [95% UI] 5.46–19.48) per 100,000 people in 1990 to 3.41 (95% UI 1.60–6.01) per 100,000 people in 2019, with an average annual percentage change (AAPC) (− 4.07%, P

The use of urban green spaces (UGS) depends on its quality, which is perceived very differently by diverse socio-demographic groups. In particular, elderly people have special demands on the UGS quality. It is essential to know these demands to create an equitable UGS supply. We present an approach to determining some qualitative aspects and the supply of cultural ecosystem services of diverse forms of UGS. This is realised by combining user demands with actual UGS features. In a concrete example, we assessed the UGS quality and supply for both the general population and the subset of elderly people. For the latter group, the activities of relaxing and observing nature, as well as the UGS feature of benches, were found to be significantly more important than for the general population. Nevertheless, this had only a minor impact on the assessed aspects of UGS quality and supply, with little differences detected between the two groups. In Dresden (Germany), we determined that almost half of the elderly population are not provided with high-quality UGS. In these areas, urban planning must increase the UGS quality while taking user demands into account to ensure just access to the positive benefits of UGS for the elderly.

Objectives: The role of asymptomatic infections in the transmission of COVID-19 have drawn considerable attention. Here, we performed a meta-analysis to summarize the epidemiological and radiographical characteristics of asymptomatic infections associated with COVID-19. Methods: Data on the epidemiological and radiographical characteristics of asymptomatic infections were extracted from the existing literature. Pooled proportions with 95% confidence intervals were then calculated using a random effects model. Results: A total of 104 studies involving 20,152 cases were included. The proportion of asymptomatic individuals among those with COVID-19 was 13.34% (10.86%–16.29%), among which presymptomatic and covert infections accounted for 7.64% (4.02%–14.04%) and 8.44% (5.12%–13.62%), respectively. The proportions of asymptomatic infections among infected children and healthcare workers were 32.24% (23.08%–42.13%) and 36.96% (18.51%–60.21%), respectively. The proportion of asymptomatic infections was significantly higher after 2020/02/29 than before (33.53% vs 10.19%) and in non-Asian regions than in Asia (28.76% vs 11.54%). The median viral shedding duration of asymptomatic infections was 14.14 days (11.25–17.04). A total of 47.62% (31.13%–72.87%) of asymptomatic infections showed lung abnormalities, especially ground-glass opacity (41.11% 19.7%–85.79%). Conclusions: Asymptomatic infections were more commonly found in infected children and healthcare workers and increased after 2020/02/29 and in non-Asian regions. Chest radiographical imaging could be conducive to the early identification of asymptomatic infections.

IntroductionAs an important pathogen causing diarrheal diseases, the burden and change in the death rate of norovirus-associated diseases (NADs) globally are still unknown.MethodsBased on global disease burden data from 1990 to 2019, we analyzed the age-standardized death rate (ASDR) of NADs by age, region, country, and Socio-Demographic Index (SDI) level. The discrete Poisson model was applied in the analysis of NADs' spatiotemporal aggregation, the Joinpoint regression model to analyze the trend of death burden of NADs over 30 years, and a generalized linear model to identify the risk factors for the death rate from NADs.ResultsThe ASDR of NADs significantly decreased by a factor of approximately 2.7 times, from 5.02 (95% CI: 1.1, 11.34) in 1990 to 1.86 (95% CI: 0.36, 4.16) in 2019 [average annual percent change (AAPC) = −3.43, 95% CI: −3.56, −3.29]. The death burden of NADs in 2019 was still highest in African regions despite a great decline in recent decades. However, the ASDR in high SDI countries presented an uptrend [0.12 (95% CI: 0.03, 0.26) in 1990 and 0.24 (95% CI: 0.03, 0.53) in 2019, AAPC = 2.52, 95% CI: 2.02–3.03], mainly observed in the elderly over 70 years old. Compared to children under 5 years old, the 2019 death rate of elderly individuals over 80 years old was much higher in high SDI countries. The generalized linear model showed that factors of the number of physicians (RR = 0.67), the proportions of children under 14 years old (RR = 1.21), elderly individuals over 65 years old (RR = 1.13), educational level (RR = 1.03) and urbanization proportion (RR = 1.01) influenced the ASDR of NADs.ConclusionsThe death burden of NADs has remained high in developing regions over the last three decades and has increased among the elderly in countries with high SDI levels, even though the global trend in NAD-associated deaths has decreased significantly in the past three decades. More effective public health policies against NADs need to be implemented in high SDI regions and for the elderly.

Abstract Access to treatment for acute malnutrition remains a challenge, in part due to the fragmentation of treatment programmes based on case severity. This paper evaluates utilization patterns, outcomes and associated costs for treating acute malnutrition cases among a cohort of children in Burkina Faso. This study is a secondary analysis of a proof‐of‐concept trial, called Optimizing treatment for acute Malnutrition (OptiMA), conducted in Burkina Faso in 2016. A total of 4958 eligible children whose mid‐upper arm circumference (MUAC) was less than 125 mm or with oedema were followed weekly and given ready‐to‐use therapeutic foods (RUTF). We evaluated the service utilization and outcomes among patients and estimated resource use and variable cost per patient, and examined factors driving variation in resource use. Children with lower initial MUAC level grew faster but required more time to recover than those with higher initial MUAC level. They also had higher rates of death, default and nonresponse. The simplified OptiMA approach for treating acute malnutrition achieved high rates of recovery overall (84%), especially among less severe cases, with modest quantities of RUTF. The average overall variable cost per child admitted was US$38.0 (SD: 20.5) half of which was accounted for by the cost of RUTF. Cost per recovered case was correlated with case severity, ranging from US$35.1 to US$132.8. If simplified integrated programmes using severity‐based RUTF dosing can increase access to treatment at earlier, less severe stages of acute malnutrition, they can help avoid more serious and costlier cases.

# Background After years of increased human immunodeficiency virus (HIV) investments in Tanzania, the United States Presidents Emergency Program for the AIDS Response (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) have signaled that their financing will plateau or decline in the coming years, despite remaining challenges to reaching the Fast-Track 95-95-95 goals. To plan for these challenges, the Tanzania Ministry of Health and local partners requested an update to the country’s HIV investment case, recognizing that domestic financing will also be severely constrained over the coming decade. # Methods Using the Goals model, five program scenarios (2019-30) were modeled and their health impacts and costs compared. Two scenarios were coverage-driven, Constant Coverage (CC) and the National Strategy (NS) while the three remaining scenarios explored how limited resources could be optimized through prioritization of prevention interventions, raising efficiency of treatment, and expanding cost-effective testing modalities. The resource envelopes used for resource-constrained scenarios were: same funding as the CC scenario, declining donor funds, and declining donor funds offset by domestic resource mobilization. # Results Implementing the NS is estimated to cost US$8.1 billion over 2019-30, a 40% increase over the CC scenario. If the same funds needed to maintain CC were optimized, the NS goals could be achieved for US$2.5 billion less. If donor funds decline and domestic funding is not mobilized, even with optimization new HIV infections would increase by 7% and acquired immunodeficiency syndrome (AIDS)-related deaths by 24%. However, if the government can mobilize an average year on year increase of US$10.8 million, optimization would allow the country to achieve its ambitious Fast-Track goals. # Conclusions If donor funds for HIV decline as announced, the Government needs to proactively optimize the response and invest more domestic resources to compensate, in order to achieve HIV epidemic control. Otherwise, national goals could be compromised. Other high burden countries can consider a similar investment case approach in the current era of fiscal constraints, which have been further exacerbated by COVID-19.

Limiting land take is an important sustainability target. To this end, infill development is a primary strategy. To implement this strategy, policy-makers need a reliable knowledge base on infill development potential (IDP), such as brownfields, vacant lots and underused lots. This study presents the results of the first comprehensive national survey of IDP in Germany. Almost 12% of German municipalities were contacted by questionnaire. In contrast to previous studies, this study also takes into account smaller towns and small-scale vacant lots, which would otherwise lead to a considerable underestimation. Additionally, a feasibility study shows how IDPs can be identified using a geospatial approach. Here, a procedure is presented that allows the identification of IDPs and the differentiation between vacant and underused lots by analysing urban morphology using nationwide and commonly available geospatial base data. The results provide a good basis for an initial inventory. However, to obtain more accurate results, additional specific data would be required, the accessibility of which is currently limited. With the development of an improved spatial data infrastructure combined with Open Data initiatives, geographical information system (GIS)-based procedures for the automated detection and monitoring of IDPs could become more important in future. POLICY RELEVANCE If the objectives of land policy, especially the avoidance of urban sprawl, are to be achieved, then the more efficient use of already developed land is essential. At the strategic level of policy development, knowledge of land suitable for infill development is as necessary as knowledge of the land take. Currently, regular standardised questionnaire surveying is the effective method for analysing infill development potential (IDP) and its development on a large scale. Geospatial approaches can help to identify potentials, especially on vacant and underused lots. Thus, they have a considerable potential to serve as heuristic tools for local practitioners seeking to begin reflecting on infill development options. Policy-makers and planners should recognise this potential and develop it further in cooperation with the scientific community. However, decision-makers are not spared from weighing the appropriate density in the respective context—and this has not become easier under the impact of the current COVID-19 pandemic.

Landscapes and human settlements evolve over long periods of time. Land change, as one of the drivers of the ecological crisis in the Anthropocene, therefore, needs to be studied with a long-term perspective. Over the past decades, a substantial body of research has accumulated in the field of land change science. The quantitative geospatial analysis of land change, however, still faces many challenges; be that methodological or data accessibility related. This editorial introduces several scientific contributions to an open-access Special Issue on historical settlement and landscape analysis. The featured articles cover all phases of the analysis process in this field: from the exploration and geocoding of data sources and the acquisition and processing of data to the adequate visualization and application of the retrieved historical geoinformation for knowledge generation. The data used in this research include archival maps, cadastral and master plans, crowdsourced data, airborne LiDAR and satellite-based data products. From a geographical perspective, the issue covers urban and rural regions in Central Europe and North America as well as regions subject to highly dynamic urbanization in East Asia. In the view of global environmental challenges, both the need for long-term studies on land change within Earth system research and the current advancement in AI methods for the retrieval, processing and integration of historical geoinformation will further fuel this field of research.

We compare different matching methods for distinguishing building modifications from replacements based on multi-temporal building footprint geometries from 3D city models. Manually referenced footprints of building changes were used to determine which thresholds are suitable for distinction. In addition, since the underlying LoD1 (Level of Detail 1) data is highly accurate, randomly generated position deviations were added to allow for transferability to less well-matched data. In order to generate a defined position deviation, a novel method was developed. This allows determination of the effects of position deviations on accuracy. Determination of these methods’ suitability for manipulation of data from sources of different levels of generalization (cross-scale matching) is therefore not the focus of this work. In detail, the methods of ‘Common Area Ratio’, ‘Common Boundary Ratio’, ‘Hausdorff Distance’ and ‘PoLiS’ (Polygon and Line Segment based metric) were compared. In addition, we developed an extended line-based procedure, which we called ‘Intersection Boundary Ratio’. This method was shown to be more robust than the previous matching methods for small position deviations. Furthermore, we addressed the question of whether a minimum function at PoLiS and Hausdorff distance is more suitable to distinguish between modification and replacement.

Urban Growth Boundary (UGB) is a growth management policy that designates specific areas where growth should be concentrated in order to avoid urban sprawl. The objective of such a boundary is to protect agricultural land, open spaces and the natural environment, as well as to use existing infrastructure and public services more efficiently. Due to the inherent heterogeneity and complexity of settlements, UGBs in Germany are currently created manually by experts. Therefore, every dataset is linked to a specific area, investigation period and dedicated use. Clearly, up-to-date, homogeneous, meaningful and cost-efficient delineations created automatically are needed to avoid this reliance on manually or semi-automatically generated delineations. Here, we present an aggregative method to produce UGBs using building footprints and generally available topographic data as inputs. It was applied to study areas in Frankfurt/Main, the Hanover region and rural Brandenburg while taking full account of Germany’s planning and legal framework for spatial development. Our method is able to compensate for most of the weaknesses of available UGB data and to significantly raise the accuracy of UGBs in Germany. Therefore, it represents a valuable tool for generating basic data for future studies. Application elsewhere is also conceivable by regionalising the employed parameters.

Public urban green spaces are important for the urban quality of life. Still, comprehensive open data sets on urban green spaces are not available for most cities. As open and globally available data sets, the potential of Sentinel-2 satellite imagery and OpenStreetMap (OSM) data for urban green space mapping is high but limited due to their respective uncertainties. Sentinel-2 imagery cannot distinguish public from private green spaces and its spatial resolution of 10 m fails to capture fine-grained urban structures, while in OSM green spaces are not mapped consistently and with the same level of completeness everywhere. To address these limitations, we propose to fuse these data sets under explicit consideration of their uncertainties. The Sentinel-2 derived Normalized Difference Vegetation Index was fused with OSM data using the Dempster–Shafer theory to enhance the detection of small vegetated areas. The distinction between public and private green spaces was achieved using a Bayesian hierarchical model and OSM data. The analysis was performed based on land use parcels derived from OSM data and tested for the city of Dresden, Germany. The overall accuracy of the final map of public urban green spaces was 95% and was mainly influenced by the uncertainty of the public accessibility model.

# Background Worldwide more than 125 million people are infected with hepatitis C (HCV). New drugs, direct acting antivirals (DAAs) that can cure HCV in three months, are available in generic form at very low cost in over 100 low- and middle-income countries, yet few countries have launched national campaigns. In Morocco, more than 350,000 people are infected with chronic HCV infection yet only 1,500 individuals with mandatory social health insurance are currently treated each year with DAAs. Such treatment coverage is low for this group and is completely inaccessible to the remaining 70% of the population. # Methods To accelerate progress in Morocco, our team of advocates, clinicians, and health policy analysts developed an investment case, using a novel set of tools, that modeled HCV elimination by 2030 and estimated the health impact, costs, cost-effectiveness, return on investment, and budget implications of such an effort. # Results Our analysis suggests that Morocco could eliminate HCV and save over 50,000 lives by investing US\$650-715 million in a highly cost-effective manner (US\$1,700 per DALY averted, less than half per capita GDP) and by allocating 3.5% of the Ministry of Health's budget. # Conclusions The investment case has been accepted by the Ministry of Health, and Morocco has committed to putting 6,500 patients on treatment in the public sector in 2018-2019 for the first time, targeting the poorest who are eligible for a new social health insurance program. Our experience shows how the investment case method we followed can be used to drive decisions on HCV elimination in favor of more efficient and equitable use of resources.

Due to financial or administrative constraints, access to official spatial base data is currently limited to a small subset of all potential users in the field of spatial planning and research. This increases the usefulness of Volunteered Geographic Information (VGI), in particular OpenStreetMap (OSM), as supplementary datasets or, in some cases, alternative sources of primary data. In contrast to the OSM street network, which has already been thoroughly investigated and found to be practically complete in many areas, the degree of completeness of OSM data on buildings is still unclear. In this paper we describe methods to analyze building completeness and apply these to various test areas in Germany. Official data from national mapping and cadastral agencies is used as a basis for comparison. The results show that unit-based completeness measurements (e.g., total number or area of buildings) are highly sensitive to disparities in modeling between official data and VGI. Therefore, we recommend object-based methods to study the completeness of OSM building footprint data. An analysis from November 2011 in Germany indicated a completeness of 25% in the federal states of North Rhine-Westphalia and 15% in Saxony. Although further analyses from 2012 confirm that data completeness in Saxony has risen to 23%, the rate of new data input was slowing in the year 2012.

Information on the distribution and dynamics of dwellings and their inhabitants is essential to support decision-making in various fields such as energy provision, land use planning, risk assessment and disaster management. However, as various different of approaches to estimate the current distribution of population and dwellings exists, further evidence on past dynamics is needed for a better understanding of urban processes. This article therefore addresses the question of whether and how accurately historical distributions of dwellings and inhabitants can be reconstructed with commonly available geodata from national mapping and cadastral agencies. For this purpose, an approach for the automatic derivation of such information is presented. The data basis is constituted by a current digital landscape model and a 3D building model combined with historical land use information automatically extracted from historical topographic maps. For this purpose, methods of image processing, machine learning, change detection and dasymetric mapping are applied. The results for a study area in Germany show that it is possible to automatically derive decadal historical patterns of population and dwellings from 1950 to 2011 at the level of a 100 m grid with slight underestimations and acceptable standard deviations. By a differentiated analysis we were able to quantify the errors for different urban structure types.

This study was undertaken to assess the impact of obesity on fetal well-being in glucose-tolerant and nonhypertensive women. Medical charts of all patients admitted to the labor and delivery department at our institution between January, 2011 and July, 2011 were retrospectively reviewed. Patients with diabetes/impaired glucose tolerance or hypertension were excluded. A total of 100 women, 50 lean and 50 obese, were included. Umbilical artery blood gas parameters (BGPs) were compared in lean (

Monitoring urban growth and measuring urban sprawl is essential for improving urban planning and development. In this paper, we introduce a supervised approach for the delineation of urban areas using commonly available topographic data and commercial GIS software. The method uses a supervised parameter optimization approach along with buffer-based quality measuring method. The approach was developed, tested and evaluated in terms of possible usage in monitoring built-up areas in spatial science at a very fine-grained level. Results show that built-up area boundaries can be delineated automatically with higher quality compared to the settlement boundaries actually used. The approach has been applied to 166 settlement bodies in Germany. The study shows a very efficient way of extracting settlement boundaries from topographic data and maps and contributes to the quantification and monitoring of urban sprawl. Moreover, the findings from this study can potentially guide policy makers and urban planners from other countries.

Since the early 2000s, aid organizations and developing country governments have invested heavily in AIDS treatment. By 2010, more than five million people began receiving antiretroviral therapy (ART)--yet each year, 2.7 million people are becoming newly infected and another two million are dying without ever having received treatment. As the need for treatment grows without commensurate increase in the amount of available resources, it is critical to assess the health and economic gains being realized from increasingly large investments in ART. This study estimates total program costs and compares them with selected economic benefits of ART, for the current cohort of patients whose treatment is cofinanced by the Global Fund to Fight AIDS, Tuberculosis and Malaria. At end 2011, 3.5 million patients in low and middle income countries will be receiving ART through treatment programs cofinanced by the Global Fund. Using 2009 ART prices and program costs, we estimate that the discounted resource needs required for maintaining this cohort are $14.2 billion for the period 2011-2020. This investment is expected to save 18.5 million life-years and return $12 to $34 billion through increased labor productivity, averted orphan care, and deferred medical treatment for opportunistic infections and end-of-life care. Under alternative assumptions regarding the labor productivity effects of HIV infection, AIDS disease, and ART, the monetary benefits range from 81 percent to 287 percent of program costs over the same period. These results suggest that, in addition to the large health gains generated, the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.